Health Insurance and You!

Wherever you go today, the topic of conversation is the new federal guidelines regarding mammograms and self-testing to detect breast cancer. This is a highly charged issue. After all, who doesn’t know someone who has had a brush with this ubiquitous disease? In addition to our reasonable fear of cancer, the discussion is taking place against the backdrop of health reform. Here are the two sides of the conversation.

Testing at 40
Many people are appalled and frightened by the new guidelines. The public has been taught since the beginning of time that women have to conduct monthly self-exams and have annual mammograms starting at the age of 40. We have been told that early detection saves lives. There seems to be no shortage of stories about young women who would have succumbed to the disease had they not found a tumor in a mammogram.
Furthermore, these new guidelines were issued by a federal agency, the United States Preventive Services Task Force, which according to the New York Times, arrived at the exact opposite conclusion after conducting studies only seven years ago. If your life, or the life of someone you love is at stake, why would you take a risk that a few years down the road they will reverse direction again?
Finally, because the recommendations were made by a federal agency people fear that any new government-influenced health care system will not pay for the tests. For more on this go to www.breastcancer.org

Testing at 50
The argument for postponing mammograms and foregoing self-exams seems coolly logical. The efficacy of mammography as a life-saving procedure has been the subject of debate for years. This is not the first study to suggest that mammograms do not save lives. In fact, researchers argue that mammograms cause harm because they force people to undergo an untold number of unnecessary, painful, costly and anxiety-creating procedures for cancers that may not be life-threatening.
Additionally, it is important to remember that the guidelines do not suggest that women who may be deemed at high risk of developing cancer should not be screened early. If a doctor finds that a patient is at risk either from medication, lifestyle, genetic testing or something else, a mammogram can be ordered regardless of the patient’s age.

Patients will be calling their doctors en masse over the next week seeking advice on this subject. You may want to be one of those callers.

Since 1985, many laid off workers have been protected by the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows workers the option of keeping the health insurance coverage they had while employed for up to 18 months, as long as they can pay the full amount of the premium.

According to the Kaiser Family Foundation, a not-for-profit foundation focusing on major health care issues, the number of people taking advantage of COBRA is not available. But one study implies that only 19% of eligible people were using COBRA in early 2009. Because employer-sponsored programs cover on average 83% of health insurance premiums, individuals who find themselves laid off have the double-edged burden of a fourfold increase in their health care costs and the loss of their incomes. It is not at all surprising that so few people choose to continue their coverage.

Last March, as a part of the economic stimulus package known as the American Recovery and Reinvestment Act of 2009 (ARRA), the federal government began offering substantial subsidies to help laid off workers pay their COBRA health insurance premiums for nine months. The package offers unemployed workers a 65% discount in the cost of their premiums. The program has proven effective in that Kaiser estimates that twice as many eligible people are keeping their health insurance benefits.

Those who were among the first to apply for the ARRA subsidies are coming to the end of their eligibility for the federal discount. And eligibility to begin receiving the discount is ending in two months. While congress is considering a bill to extend the subsidies, many people are finding themselves in a difficult situation. Should they stay on COBRA even though their costs may skyrocket, or should they seek other less expensive options?

An article by M.P. McQueen in today’s Wall Street Journal quotes one human resources expert who advises that participants should remain on COBRA if they can afford it especially if they or their dependents have any pre-existing conditions. For others, Mr. McQueen exploring their options by comparison shopping for private health insurance plans.

If you find yourself in such a situation, GetInsured.com is a great place to explore your options. Knowledgeable and helpful associates will listen to your situation and provide you with easy to use information about private health plans to meet your health needs as well as your budget.

Before you finalize your health plan decisions take the time to inquire about the extra benefits that may be available. Supplemental benefits may include dental expenses, vision care, Medicare supplemental insurance, alternative medicine and other health-related expenses not covered by your health insurance.

To be adequately insured you need to assess your medical priorities. Do you think you might need extra care? If there is a particular expense you are concerned about, make sure to ask about it.

Understanding the benefits you will receive with your new policy will not only help you determine what, if any supplemental products you need, but will also help you take full advantage of the benefits to which you are entitled. Find out if you are eligible for a discount on fitness club membership, glasses or physical therapy for example, and then be sure to use it!

I found this article funny and, while exaggerated, it shines a light on the inefficiency and lack of customer service in the health care delivery system. It was written by Jonathan Rauch and published on NationalJournal.com. Happy reading!

If Air Travel Worked Like Health Care
Fasten your seat belts — it’s going to be a bumpy flight.
by Jonathan Rauch

“Hello! Thank you for calling Air Health Care, the airline that works like the health care system. My name is Cynthia. How can I give you travel care today?”

“Hi. My name is Jonathan Rauch. I need to fly from Washington, D.C., to Eugene, Oregon, on October 23.”

“Yes, I’d be happy to assist you with that. It does look like we can get you on a flight on January 23 at 1 p.m. or February 8 at 3 p.m. Which would you prefer?”

“Neither. I need to be in Eugene on October 23. As in, the 23rd of October.”

“I’m sorry, we have nothing open on that date. You might try another carrier.”

“I suppose I’d better. Who has availability?”

“I’m afraid I have no way to know that. I have no way to look into their systems.”

“Who would know?”

“You can call them individually and ask. I’m sure you can find one.”

“Look, I don’t have time to call two dozen airlines. It’s important that I get to Eugene on the 23rd. There must be something you can do.”

“Well, it looks like maybe we could squeeze you in on October 26, if you don’t mind departing Washington Dulles at 5:35 a.m.”

“Good grief. All right, I suppose it will do.”

“I’m sorry, sir, we don’t use e-mail to transmit records and other personal or secure documents. We keep our records on paper.”

“Great, thank you, I’ll be happy to make that booking for you. That’s one flight from Washington Dulles to Chicago O’Hare on October 26. Will there be anything else?”

“Wait, hold on. Chicago? I’m going to Eugene. It’s in Oregon.”

“Yes, sir. The Eugene portion of your trip will be handled by a western specialist. We’ll be glad to bring you back from Chicago to Washington, though.”

“You mean I have to call another carrier and go through all this again? Why don’t you just book the whole trip?”

“Sorry, sir, but you do need to make your own travel appointments. We would be happy to refer you to some qualified carriers. May I have your fax number, please? Before I can confirm the booking, we’ll need you to fill out your travel history and send that back to us.”

“Cynthia, I have filled out my travel history half a dozen times already this year. I’ve told six different airlines that I flew to Detroit twice and Houston once. Every time I fly, I answer the same battery of questions. At least a dozen airlines have my travel history. Why don’t you get it from them?”

“We have no way we could do that. We do not have access to other companies’ records, and our personnel have our own system for collecting travel history.”

“But 95 percent of these questions are always the same. Don’t you know that every time I fill out one of these duplicative forms I increase the chance of error? Wouldn’t it make more sense to hold my travel information centrally, so that everyone could see the same thing?”

“Sorry, sir, we have no capability for that, and we do need to have your travel history at least two weeks before you fly.”

“I don’t suppose I could fill out these forms online?”

“No, sir. The forms are only about 30 pages, though. Did you have that fax number, please?”

“I don’t have a fax machine. No one faxes anymore. Just e-mail me the forms.”

“I’m sorry, sir, we don’t use e-mail to transmit records and other personal or secure documents. We keep our records on paper.”

“What century is this? You think paper is secure?”

“We do keep all your travel records on low-acid paper and in fire-retardant file drawers. When someone needs access to your records, we make a photocopy and put them in the mail. Or fax. How many items of luggage were you wanting to bring?”

“Two.”

“OK, good. We suggest you make luggage arrangements with Rapid Air Transport, though of course you’re free to use any luggage company you like.”

“Luggage company?”

“Yes, sir. You’ll need to arrange baggage transport. Would you like a phone number for Rapid, or would you prefer to find your own baggage company? I’m sure Rapid would be pleased to work with you. All you need to do is sign the Personal Travel Records Release form. Where would you like me to mail that?”

“Release form?”

“Yes, sir. You’ll need to sign and fax or mail that back to our Travel Records Department so that we can release your travel records to Rapid. Under the privacy rules, we’re not authorized to tell them when or where you’re flying without your written permission.”

“I suppose I couldn’t just e-mail you this permission, or grant it online?”

“No. Did you want a list of luggage carriers for your Chicago-Eugene leg?”

“Let me guess. Rapid doesn’t operate out West. I have to find a separate luggage company for the second leg.”

“Yes, sir.”

“And they’ll need more copies of all the same paperwork. And they’ll ask me all the same questions. And I’ll have to arrange to get my travel records to them by mail or fax. And I’ll repeat all this nonsense five or six separate times between here and Eugene, because the providers aren’t equipped to talk to each other and my records aren’t digitized and no two providers use the same system.”

“Yes, sir, that’s right! Did you have a preferred fuelist, or did you want a reference for a company to provide jet fuel for your flight?”

“Fuelist. That would be a fuel specialist, I suppose.”

“We can make a fuel arrangement for you, but please be advised that the fuelist’s charge will be billed separately and you will be responsible for it. We’ll need to know where to have that bill sent.

“May I have your flight-insurance information, please?”

“Millennium Travel Care, group number 068832, ID number RS-3390041B.”

“I’m sorry, sir, we’re not in Millennium Travel Care’s provider network.”

“You’re listed on their website. It says you accept Millennium.”

“We did until last week. If you like, you can pay out of pocket for your ticket.”

“How much would that be?”

“Yes, sir, I’ll be happy to get that price for you. That would be $17,885.70.”

“What? For a flight to Chicago? Does anyone actually pay that?”

“I’m sorry, sir, I wouldn’t know. I can tell you that different clients and insurers pay different rates. For individuals, the rate is $17,885.70.”

“Oh.”

“In a sane system, I would call an airline and it would give me a price for the whole trip, not just for one part of it.”

“Plus tax. And fuel.”

“Is anyone else cheaper?”

“Sir, again, I couldn’t tell you that. Carriers don’t have public rate sheets. Prices are privately negotiated, so there’s really no way you could comparison shop.”

“Oh.”

“Did you want to go ahead, then?”

“No. I DO NOT WANT TO GO AHEAD. I do not want to go anywhere! I want to jump off a cliff!

“This system is insane. It is fragmented to the point of incoherence. Record-keeping is stuck in the 1960s. Communication is stuck in the 1980s. None of the systems talks to the others. Everyone reinvents the wheel at every stage of the process. There is no pricing transparency.

“In a sane, modern system, I wouldn’t have to arrange each leg of my flight myself. I wouldn’t have to fax documents around, find and juggle multiple providers, fill out again and again what are essentially the same forms every time I use a provider.

“In a sane system, I would call an airline and it would give me a price for the whole trip, not just for one part of it. It would sell me a safe round-trip journey, instead a series of separate procedures. It would have back-office personnel using modern IT systems to coordinate my journey behind the scenes. The systems and personnel would talk to each other automatically. At the press of a button, once I entered a password, they would be able to look up my travel history. We’d do most of this stuff online.

“In fact, Cynthia, I would be able to arrange a whole trip with a single phone call!”

“Sir. Please. Calm down and be realistic. I’m sure the system can be frustrating, but consumers don’t understand flight plans and landing slots. Even if they did, there are thousands of separate providers involved in moving travelers around, and hundreds of airports, and millions of trips. Getting everyone to coordinate services and exchange information just isn’t realistic in a business as complicated as travel.”

“Yes. I suppose I’m dreaming.”

“Was there anything else I could help you with?”

“No.”

“My goal today was to provide you with outstanding service. Did I accomplish that?”

[click]

When signing up for employee-sponsored health insurance, enrollees are either presented with a small number of options or no choices at all. The company selects the plan for its employees. In contrast, when buying individual insurance, the possibilities are practically endless. First, an individual has to choose the carrier. Which insurer has the best network of hospitals and health care professionals, has a good reputation for customer support, makes timely reimbursements, provides the most services and has a high rating for financial strength? Next, the customer has to determine how to allocate his or her spending among premiums, deductibles, co-insurance, out-of-network fees and out-of-pocket expenses. What about special benefits such as dental care, vision and long-term health? You get the idea.

This is where a health care exchange comes in. An exchange uses the information a person provides about his or her needs and budget to intelligently narrow down the choices to a few relevant plans. Online or on the phone, an exchange will provide a personal, helpful side-by-side comparison of available plans in a selected a price range. The exchange’s team of health insurance experts will answer questions and help the customer navigate the process through to the application. Best of all, this help is free. GetInsured.com is a premier health care exchange that offers knowledgeable service representatives, a huge variety of available plans and customer friendly online comparison-shopping. Check it out!

An estimated 26 million Americans are currently without insurance, presumably because the price is too high. Yes, health care reform will help this group of people by subsidizing a basic insurance policy. But the promise of a better deal looming on the horizon is actually causing harm. How many of those who are currently uninsured could afford at least some minimal coverage now but are deferring their purchase while waiting for reform?

We heard in President Obama’s address to Congress that federal reform may take 3-5 years to take effect. I urge everyone to not put off this decision. Individual plans aren’t necessarily more expensive than employer-based plans and can be tailored to offer benefits for an individual’s needs and exclude benefits mandated for employer-based plans. For example, there are low-cost plans available that provide catastrophic coverage. Such an inexpensive plan won’t cover preventive and non-urgent care, but it will pay for treatment in the case of an unexpected accident or serious illness while saving the individual from financial ruin.

Another possibility for those seeking minimal coverage while waiting for federal reform is a short term policy. A short term policy typically lasts six months, and the insurer is not obligated to renew it, but can be an affordable interim solution for some.

There are many people who could and should be getting more coverage than they currently have, rather than waiting for health reform legislation to pass before taking action. And, when a health reform law is passed, those who are eligible can supplement their insurance with more complete, subsidized coverage.

The goals of health care reform legislation are universal coverage and cost control. Logic tells us that increasing the demand for medical care while keeping costs in check is a formidable challenge. Now we have data to confirm and quantify just how challenging it is. Over the weekend, The Boston Globe reported the results of a study by a non-profit health care foundation called The Commonwealth Fund that tracked the cost of premiums for a family of four from 2003–2008. Massachusetts is being watched as a case study for health reform because in 2006 it enacted the nation’s first universal coverage law.
Over that five-year period, health insurance premiums offered by employers, rose 40% to $13,788, the highest in the country. For the rest of the nation the increase was lower than Massachusetts, but still unacceptably high at 33%. This can’t go on.

There are many cost-savings ideas being debated. We should consider the options based on the potential benefit and also on their ease of implementation. Those ideas that are high on both dimensions should be at the top of our national to-do list. The ideas that are most hotly debated are actually those that are high-impact but difficult to implement or low-impact and easy to implement. They include pay-for-performance, incentives for primary and preventive care and reducing profits and administrative costs for insurers.

High-impact/difficult to implement

• Pay-for-performance: While we are very likely heading toward a pay-for-performance model, the details are controversial and implementation will take many years.
• Incentives for primary and preventive care: Motivating patients to rely more on primary care sounds reasonable, but we have a critical shortage of primary care physicians across the country. Waits to see a primary care physician for an initial examination can be more than a year. Remedying the shortage will take time.

Moderate-impact/some difficulty to implement:

• Reducing profits and administrative costs for insurers: For-profit health insurance companies earn an average of 3-4% of revenues – so there is not too much to gain here. On the other hand, administrative costs average 12-13% of revenue and represent some opportunity for savings. We should be careful here – for-profit companies have a strong built-in incentive to reduce costs, so getting below 12% must be difficult to do.

While these ideas should be pursued, there are some cost savings ideas that are high-impact and easy to implement. They have not received as much attention but are worthy of a closer look.

High impact/easy to implement

• Fraud control: Detecting and combating fraud is an opportunity for savings that is both substantial and uncomplicated. Fraudulent claims cost payers, and consumers, more than a hundred billion dollars each year. Efforts on this front will benefit everyone while more systemic changes get underway.
• Incentive compatibility: Health savings accounts, HSAs, with higher deductibles are an innovation in both employer-sponsored and individual plans that merit close observation. HSAs effectively put consumers in charge of their own health care spending and reward them with tax-deferred medical accounts. Finally, the incentives of the consumers match the incentives of the providers instead of working against each other.

When an individual applies for a mortgage loan, the loan is not extended immediately upon approval. Most states require both parties to wait three days. This time, called a rescission period, is intended to allow the borrower an opportunity to consider his choice in the comfort of his own home. He is encouraged to read the small print, and make sure that he is making the right decision for himself and his family.

Buying health insurance is at least as complicated. That’s why many states have a 10-day “free-look” period for insurance policies. Just like taking out a loan, buying insurance involves a long-term financial agreement. This is an important and personal transaction and should not be made hastily or under duress. Our company, GetInsured.com works hard to design a health insurance plan suited for each customer. Then we go one step further than any other company and the mandated free-look. From the day an application is submitted, customers have 30 days to think about their new policies. If the customer changes his mind for any reason, GetInsured.com will give him or her a full refund. No questions, no pressure. I am proud of this industry-leading practice because, after all, what is insurance for if not to provide peace of mind.

Senator Ted Kennedy served 47 years as Senator from Massachusetts. He was one of the most prolific lawmakers in history, with an impressive list of legislation bearing his name. Regardless of one’s politics, it is impossible to not admire Senator Kennedy’s dedication to and his achievements in the name of accessible and affordable health care for all. Below is a list of his contributions in the health care arena. (Read the complete text on the Senator’s web site)

1966
Created the National Community Health Center program to serve low-income patients. Today the program comprises more than 1,200 centers and serves over 20 million Americans.

1969
Gave his first speech calling for national health insurance for all Americans.

1970
Led legislation which laid the basis for the “War on Cancer” by quadrupling funds for cancer research and prevention.

1971
Chairman of the Senate Health Subcommittee. Held a series of field hearings around the country on national health insurance, and passed the National Cancer Act to expand research on all aspects of cancer. Established the National Cancer Institute.

1972
Championed the Meals on Wheels Act, which offers nutritional meals to homebound senior citizens and the Women, Infants, and Children Nutrition Program, known as WIC, which offers food, nutrition counseling, and health services to low-income women, infants, and children.

1974
Introduced comprehensive legislation providing national health insurance

1990
Introduced, with Senator Orrin Hatch, the Ryan White CARE Act, providing emergency relief to the thirteen cities most affected by AIDS and substantial assistance to all states to develop effective and cost-efficient AIDS care programs, particularly for early diagnosis and home care.

1992
Helped pass the Mammography Quality Standards Act to guarantee the safety and accuracy of mammograms and to encourage their use.

1996
With Senator Nancy Kassebaum sponsored the Health Insurance Portability and Accountability Act, which guarantees the continuation of health insurance coverage for millions of Americans who change jobs or lose their jobs. Joined a bipartisan group of Senators to enact the Mental Health Parity bill to eliminate unjust annual and lifetime limits on mental health coverage that differ from the limits for other physical illnesses.

1997
With Senator Hatch, led the successful effort to enact the Children’s Health Insurance Program, which has brought quality health care to millions of children in low- and moderate-income families.

2000
Sponsored Minority Health and Health Disparities Research and Education Act, intended to eliminate the pervasive health disparities between minorities and other Americans, and also included an authorization for significant resources to improve the delivery of health care to minorities. Sponsored the Pediatric Graduate Medical Education Act, which provides essential support for training programs at children’s hospitals across the country. Led the successful effort to provide federal compensation and medical benefits to Department of Energy employees who become ill because of their dangerous conditions at work.

2006
Sponsored the Family Opportunity Act, which enables states to expand Medicaid coverage for children with special needs and enables low- and middle-income families with disabled children to purchase coverage under Medicaid.

2007
Renewed the Ryan White Care Act with greater focus on prevention, chronic care, quality of life, and new and emerging therapies for AIDS. Proposed a bill to strengthen the FDA’s regulatory authority over drugs after they are approved to ensure their safety.

2008
Enacted the Mental Health Parity Act, requiring insurance companies to provide benefits for mental illnesses equal to the benefits for physical illnesses and assuring equity for 113 million Americans. Also led the enactment of the Genetic Information Nondiscrimination Act, prohibiting insurers and employers from discriminating against people due to their genes.

2009
Championed the health and employment provisions of the American Recovery and Reinvestment Act, to promote investment in health information technology and to help those who lose their jobs to keep their health insurance.

http://www.aishealth.com/Bnow/hbd061509.html

Baucus, Grassley Paper Describes Exchange

The SFC policy options paper, issued by Committee Chairman Max Baucus (D-Mont.) and minority ranking member Chuck Grassley (R-Iowa), describes a single national exchange that enables state-specific information to be displayed to residents. The exchange would:

1. Require all insurers that sell individual and small-group products to participate in the exchange. All insurers would be required to sell four standardized benefit options that have an actuarial value (defined as the percentage of health care costs covered by the product) ranging from 76% for the lowest option to 93% for the highest.

2. Allow individuals and very small groups to purchase the standardized products either through the exchange or buy products directly from an agent, broker or insurance company. All products, whether purchased inside or outside the exchange, would have to meet new rating and benefit requirements. And only individuals purchasing products through the exchange would be eligible for tax credits.

3. Require all individuals to purchase coverage, either through the individual or group market.

4. Initially limit participation to individuals and “micro-groups” of two to 10 employees.

5. Use a standard enrollment application and a standardized format for presenting insurance options.

6. Create marketing rules modeled on the Medicare Advantage (MA) program.

7. Establish rate schedules for broker commissions.

8. The HHS secretary could contract with a private entity to operate the exchange. The SFC policy options paper also suggests that several competing exchanges could be established in each state.